Predictive accuracy of cerebroplacental ratio measured at 34–37 weeks’ gestation for perinatal outcome in fetal growth restriction

Abstract

Background and aim Fetal growth restriction (FGR) is a clinical and public health challenge that confers an increased risk of intrapartum and neonatal adverse outcomes. Doppler indices, particularly cerebroplacental ratio (CPR), may be useful in predicting adverse outcomes in pregnancies with FGR. We aimed to evaluate the potential value of CPR at 34–37 weeks’ gestation in predicting the perinatal outcome of pregnancies with FGR.Patients and methods A prospective observational study on singleton pregnancies with FGR, who underwent estimated fetal weight assessment and Doppler indices, including CPR, umbilical artery pulsatility index (PI), and middle cerebral artery pulsatility index (PI) at 34–37 weeks’ gestation. Patient characteristics, and intrapartum and neonatal outcomes were recorded. The main outcomes were a need for urgent cesarean section due to intrapartum fetal compromise, 5-min Apgar score below 7, neonatal death, and admission at neonatal ICU.Results Out of from 80 women participated in the current study, 16 women had an unfavorable outcome in their newborns. abnormal CPR (<1.08) was present in 27.5% of cases and was associated with a higher risk of adverse outcomes. The sensitivity and specificity of CPR in predicting adverse neonatal outcomes were 62.50 and 81.25%, respectively, and its diagnostic accuracy was superior to either umbilical artery pulsatility index or middle cerebral artery PI alone.Conclusion CPR measured at late gestation seems to be a useful method for predicting adverse intrapartum and neonatal outcomes in pregnancies with FGR. Routine measurement of CPR may decrease the incidence of these adverse outcomes.